우리나라 의사양성체제의 역사와 미래

안덕선,한희진,Ahn, Duck-Sun,Han, Hee-Jin 연세대학교 의과대학 2018 의학교육논단 Vol.20 No.2

Western medicine was first introduced to Korea by Christian missionaries and then by the Japanese in the late 19th century without its historical, philosophical, cultural, social, political, and economic values being communicated. Specifically, during the Japanese colonial era, only ideologically 'degenerated' medicine was taught to Koreans and the main orthodox stream of medicine was inaccessible. Hence, Korean medical education not only focuses on basic and clinical medicine, but also inherited hierarchical discrimination and structural violence. After Korea's liberation from Japan and the Korean war, the Korean medical education system was predominantly influenced by Americans and the Western medical education system was adopted by Korea beginning in the 1980s. During this time, ethical problems arose in Korean medical society and highlighted a need for medical humanities education to address them. For Korean medical students who are notably lacking humanistic and social culture, medical humanities education should be emphasized in the curriculum. In the Fourth Industrial Revolution, human physicians may only be distinguishable from robot physicians by ethical consciousness; consequentially, the Korean government should invest more of its public funds to develop and establish a medical humanities program in medical colleges. Such an improved medical education system in Korea is expected to foster talented physicians who are also respectable people.

의사 양성 정책

안덕선(Duck -Sun Ahn) 한국의학교육학회 2007 Korean journal of medical education Vol.19 No.1

예과 입학성적, 졸업 총 평점, 의사 국사고시간의 상관관계 및 성별 비교에 관한 연구 고려의대

안덕선(Duck sun Ahn),임형(Hyung Im),김경성(Kyung-Sung Kim) 한국의학교육학회 2000 Korean journal of medical education Vol.12 No.1

이상의 결과를 종합하면 전체 자료를 사용한 경우 졸업 총 평점만 국가고시 성적을 잘 예측하고 입학 성적은 졸업 총평점 또는 국가고시 성적을 예측할 수 없는 것으로 나타났다. 남학생의 자료를 사용한 경우 전체 자료를 사용한 것과 같은 결과를 보여주었다. 여학생의 경우 입학성적과 졸업 총평점이 국가고시 성적을 예측할 수 있으나 입학성적은 졸업 총평점을 예측할 수 없는 것으로 나타났다. 여학생의 예과 입학성적이 남학생의 것보다 중요한 의미를 갖는 것을 알 수 있으며 이에 관한 추가 연구가 필요한 것으로 보여진다. It is not well known in Korea if the entrance examination score has any predictive validity on the graduation score and national licensure examination. In addition, the gender effects of the three scores were investigated. The study was conducted using two years data of the three scores. The three scores from students of class of 98 and 99 were collected. Students who could not complete the medical education in four years were excluded. Also students who could not pass the national licensure examination were excluded as well. Correlations among the three scores were calculated and gender effect was examined by t- test. For the statistical process, SPSS 9.0 was used. The correlation between the scores of the entrance examination and graduation examination is not significant at 5% level. The correlation between the scores of the entrance examination and national licensure examination is not significant at 5% level. The correlation between graduation examination and national licensure examination;0.635 is highly significant at 0.1% level. The score difference between male and female at the entrance examination was not significant at 5% level. The score difference between male and female at the graduation examination and national licensure examination was highly significant at 0.1% level.

심근 수축력 저하를 유발하는 Ryanodine의 작용 기전

안덕선(Ahn, Duck-Sun),서창국(Suh, Chang-Kook),강두희(Kang, Doo-Hee) 대한생리학회 1987 대한생리학회지 Vol.21 No.2

Since it has been known that ryanodine has a potent negative inotropic effect on the cardiac muscle contractility (Jenden and Fairhurst, 1968), ryanodine has been a subject of intensive research (Frank and Sleator, 1975; Jones et al, 1978; Sutko et al, 1985). However, the underlying mechanism for the ryanodine dependent negative inotropic effect is still uncertain. In this study, the effects of ryanodine on the generation and relaxation of contracture due to Na-withdrawal and on the force-frequency relationship of heart muscles isolated from rats and guinea pigs were measured in an effort to understand the underlying mechanism of the ryanodine-induced negative inotropy. Results are summerized as follows: 1 ) Ryanodine significantly reduced the contractility of heart muscles produced at low frequency of stimulation, but showed a little effect on the contractility at high frequency stimulation. 2) Ryanodine, at the concentrations ranging from 10^-6 M to 10^-8 M, had no significant effect on the Na-dependent relaxation of Na-withdrawl contracture. 3) Ryandoine significantly reduced the amplitude of the Na-withdrawl contracture, and this inhibitory effect was reinforced by procaine, antiagonized by caffeine and high potassium. From these results, it may be concluded that the negative inotropic effect of ryanodine is mainly due to an inhibition of calcium release from sarcoplasmic reticulum.

The Medical Council of Canada Qualifying Examination Part II 연구

안덕선(Duck Sun Ahn) 한국의학교육학회 1997 Korean journal of medical education Vol.9 No.1

The Medical Council of Canada Qualifying Examination Part II(MCCQE alpha) is a 20 station, multi-center, large scale OSCE offered for licensure purposes in Canada since 1992. The MCCQE Part I is a 2 day, 4 section, paper an d pencil examination. The content of the OSCE stations, identified as belonging to one of the 4 skill set:history taking, physical examination, management of an acute patient problem, and communications. In addition, the result of the 10 written stations assessing problem solving, and data management ability were grouped together to form a 5th skill set. MCCQEII is a criterion referenced assessment of the minimal clinical competence. The last 5 years result have been entirely satisfactory. The mean score across the 11 test centers have varied slightly, mostly due to variable representation of first time Canadian takers. The failure rates have varied from 13% to 17% for all the examinees and from 6% to 7% for the first time Canadian takers. The reliability estimates, determined by a Cronbach s alpha range from .72 to .81, and by generalizability analysis(GA) from .61 to .78. The dependability indices at the out off score were .99 for all administrations. The Canadian experience has demonstrated the feasibility of testing clinical competence using an OSCE at a licensure level. This report will describe the administrations of the MCCQEII.

본과 3학년 임상실습 오리엔테이션에 관한 연구

안덕선(Duck Sun Ahn) 한국의학교육학회 1995 Korean journal of medical education Vol.7 No.1

The socio-economic environment of the Republic of Korea is currently on the threshold of becoming that of developed country upon graduating from the league of developing countries and we are seeking i nternationalization and globalization of our society. There have been a great pressure of demands for changes in Korean medical education in line with the new socio-economic and technological changes and developments, but unfortunately there have been very little changes in Korean medical education curriculum which has been used since 1970. There appears to be a lot of disparities between the Korean medical education curriculum and those of the developed countries and our medical curriculum lags way behind in its quality standards as the medical education curricula in the North American countries and British Commonwealth countries have consistently revised and improved ever since 1970s with progress of their medical education programs, In this context it won t be an exaggeration at all even if we say that the watershed where the medical education curricula of the developed countries and that of the Korean medical education begins from the clinical practice. According to the medical education curriculum which we are applying presently, there are many cases of skipping the preparation steps and procedures in attending clinical practice sessions and this has been the main reason why the students who are on clinical practice have been unable to perform practices properly and they merely become spectators or observers due to their fear complexes and lack of clinical skill competencies. In order to tackle this problem the Medical Education Council of Korea University prepared a foundation of improvement by conducting a questionaire research on the 1993 clinical practices. Based on this research we introduced a clinical practice orientation program for a duration of one week by reducing the duration of summer vacation but without changing the 1993 curriulum. During the orientation period we tried to minimize classroom teaching and emphasized manual skill competency development based on clinical practices whereby students rotated educational stations by forming groups of 8 persons each. I, hereby, report this successful case of experiment as we have gained a high level of favorable responses from the students of the corresponding school years upon implementation of the new initiatives in three consecutive years, i.e. in 1993, 1994 and 1995.

성형외과 전공의 교육과정에 대한 연구

안덕선(Duck Sun Ahn) 한국의학교육학회 1996 Korean journal of medical education Vol.8 No.1

The Korean Society of Plastic Surgeons was first founded in 1966 and the Plastic Surgery Specialist Examination was introduced in 1975. Ever since the foundation of the society and the introduction of the Specialist System there have been outstanding progress in Plastic Surgery. Recently, the number of general hospitals producing plastic surgeons has been increasing rapidly and there is a tendency that the capacity of plastic surgery residents recruited by each university hospital has also been growing fast. In spite of this rapid growth in quantity there appears the problem of risk in quality. There, therefore, should be a review on the curriculum for the training of plastic surgery residents in order to introduce future-oriented curriculum improvements in plastic surgery. I, hereby, would like to propose a direction for plastic surgery curriculum improvement by comparing the resident training curriculum of Korea to those of other countries in this paper.

목표지향 검사에 의한 준거 점수 설정에 관한 연구

안덕선(Duck-Sun Ahn),임형(Hyung Im) 한국의학교육학회 2001 Korean journal of medical education Vol.13 No.1

의과 대학에서 통상적으로 하고 있는 평가의 일부를 이용하여 목표지향 검사를 위한 준거 설정 방법을 적용하고자 하였다. 검사도구내용분석 평가에 절대적 준거설정방법중 가장 간단한 Jaeger와 Angoff 방법을 이용하여 측정 평가에 관한 기본 개념을 의학교육평가에 도입하였다. Jaeger의 방법이 Angoff 방법보다 학생들에 대한 성적 기대치가 높게 나왔다. 아울러 두 방법 모두 통상 사용하는 상대비교 당락점인 60점보다 모두 높게 나왔다. 그러나 연구방법에서 전문 평가자를 문항 출제자에 한정시켜 평가자 집단이 3명 밖에 되지 않은 점 등 연구의 한계점이 있었다. Licensure, credentialling and academic institutions are seeking new innovative approaches to the assessment of professional competence. Central to these recent initiatives is the need to determine standards of performance, which separated the competent from the non-competent candidate. The goal of this study is to introduce the criterion referenced standard-setting methods to medical Schools. The authors used Angoff and Jaeger method, which are the simplest absolute standard setting methods. In this study, the cut-off score estimated by Jaeger method was higher than that of Angoff method.

외과계열의 졸업 후 교육과정에 관한 연구

안덕선(Duck Sun Ahn) 한국의학교육학회 1998 Korean journal of medical education Vol.10 No.2

계속되는 학문의 발달 때로는 인위적인 학문의 경계를 파괴하거나, 연속적인 세포 분열을 하여 좁고 깊은 지식을 요구하는 분과 과정을 야기시킨다. 외과의 경우도 예외는 아니어서 본래 치료 방식에 의하여 의학의 한 기술적 분야로 자리 잡았던 것이 이제는 고유의 학문 영역은 갖춘 세분화된 과목으로 자리 매김을 하게 되었다. 외과에도 불어 닥친 정보의 홍수화 현상은 당연히 외과 교육 방법의 변화를 유도하였다. 나라마다 사회 문화 환경이 달라 외과교육 역시 대단히 다양한 형태를 보이고 있다. 그러나 공유하는 특성을 살펴보면 크게 세 가지로 분류가능 하였다. 첫째로 두개의 전문의 과정을 요하는 복수전공제도와 중핵과정을 요구하는 통합교육제도 그리고 지원과 없이 단일과 내에서 모든 것이 이루어지는 단과교육제도이다. 이 세 가지 형태중 교육의 경제적 시간적 효율성을 고려한다면 종국에는 통합 과정쪽으로 방향을 잡는 것이 가장 바람직하다고 생각한다. 이러한 교육의 변화를 유도하기 위하여서는 각과마다의 벽을 허물고, 전공의 위주의 교육을 목표로 하여 중핵과정을 설정하고, 아울러 외과 총론에 대한 평가를 시행하여야 한다. 외과교육에서의 변화의 조짐은 이미 시작되었고, 그 여파는 곧 우리에게 다가올 것이다. Surgery is a science, originating from treatment methodology. It is an essential part of medicine, which treats various diseases. In the past, barbers, upon the request of physicians, were the ones who performed surgery. However, the evolution of surgery into science created the surgeon as a doctor, and not as a technician. Changes and developments in the field of medicine also lead to the creation of different branches within the surgical field. To meet current socioeconomic and educational changes, residency training in surgery must become more efficient. Traditional training in general surgery must be tailored to the needs of individual surgical subspecialties. Surgical residency training can be classified into three different categories; independent, integrated and one discipline tracks are the most commonly implemented types of surgical education. In this paper, the pros and cons of each type of educational modality are discussed and presented.

연부조직 연골종에 의한 정중, 척골포착신경병증: 증례보고

홍성택,안덕선,Hong, Sung-Taek,Ahn, Duck-Sun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Soft tissue chondroma is a rare benign tumor, found mainly on the palm and sole and grows slowly. Typically, mature hyaline cartilage is the dominant pathological feature. There are reports that assert soft tissue chondromas to be a cause of median nerve entrapment syndrome. However, this is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy. Methods: A 62 year-old woman presented with chief complaints of numbness and hypoesthesia of her right palm for 4 to 5 years, and a palpable mass on her right palm that had been increasing in size slowly for 3 years. Physical examination revealed a firm, mobile, non-tender and about $3{\times}3\;cm^2$ sized mass in the center of the right palm. Electromyography showed entrapment neuropathy of the median and ulnar nerve. Ultrasonography showed an approximately $5.7\;cm^2$ mass below the flexor tendon of ring finger. Upon surgical excision, a $3{\times}3\;cm^2$ mass attached to the flexor digitorum profundus of ring finger and redness and hypertrophy of both the median and ulnar nerve were discovered. Mass excision was performed gently and the specimen was referred for histopathologic study. Mass excision resulted in median and ulnar nerve release. Results: The pathology report confirmed the mass to be a soft tissue chondroma with mature hyaline cartilage. The patient exhibited post-operative improvement of her symptoms and did not show any complications. Conclusion: This is the first case report showing soft tissue chondroma to be a cause of simultaneous median and ulnar neuropathy.